Hemodynamic evaluation using four-dimensional flow magnetic resonance imaging for a patient with multichanneled aortic dissection

The hemodynamic function of multichanneled aortic dissection (MCAD) requires close monitoring and effective management to avoid potentially catastrophic sequelae. This report describes a 47-year-old man who underwent endovascular repair based on findings from four-dimensional (4D) flow magnetic resonance imaging of an MCAD. The acquired 4D flow data revealed complex, bidirectional flow patterns in the false lumens and accelerated blood flow in the compressed true lumen. The collapsed abdominal true lumen expanded unsatisfactorily after primary tear repair, which required further remodeling with bare stents. This case study demonstrates that hemodynamic analysis using 4D flow magnetic resonance imaging can help understand the complex pathologic changes of MCAD

Design Product-Service Systems by Using a Hybrid Approach: The Fashion Renting Business Model

As is known, sustainability issues represent one of the main challenges companies have to face. Among all, the fashion industry is considered one of the most impactful, both in terms of resource utilization and pollution. Fashion renting is a recent business model for companies to reduce their environmental footprint, following a circular economy approach. The study aims to develop and discuss the proposed hybrid approach to effectively support fashion companies in designing new business models, taking into account both the customer and the company perspective. On the one hand, agent-based modeling (ABM) allow us to represent customers’ behaviour and interaction. On the other hand, discrete event simulation (DES) paradigm is used to model fashion renting processes. Because customers’ attitude to that service reflects its successful implementation, motivators and barriers have been investigated to be included in the model. The practical implication is defining a model to support fashion companies in designing rental business models before implementing them. From a theoretical point of view, it overcomes the literature gap about the definition of a unique model for fashion renting, including processes, customers and interactions between agents. Follow-up research will include the presentation of simulation results

As Interações da Cultura Midiática na Escola

Pesquisa as interações da cultura midiática na escola. Problematiza o alto índice de consumo de mídia na atualidade e justifica a necessidade de pesquisas que deem conta de entender os sentidos dessa teia de interações, em especial a construção de sentido, em ato, entre crianças, adolescentes e cultura midiática. Adota como referencial teórico-metodológico a sociossemiótica baseando-se em Algirdas Julien Greimas, Eric Landowski, Ana Cláudia Oliveira e outros. Escolhe uma escola municipal, situada em Jardim Camburi, Vitória/Espírito Santo, como locus e sujeitos de estudo. Propõe como procedimentos metodológicos a pesquisa exploratória, descritiva e sociossemiótica, com tratamento de dados de forma qualitativa, com os métodos da observação participante, conversação, entrevista em profundidade e da pesquisa semiótica. Usa na coleta de dados as anotações em diário de bordo e fotografias. Contribui para o entendimento da construção de sentido que se estabelece, em ato, entre crianças, adolescentes e cultura midiática, e apresenta sugestões de diálogo construtivo a ser promovido pela escola

L’inibizione tireotropinica da metformina non si associa a segni cardiologici di ipertiroidismo subclinico

Recenti dati di letteratura hanno evidenziato come metformina determini una riduzione/soppressione dei livelli sierici di tireotro- pina (TSH), simulando un ipertiroidismo subclinico il cui signifi- cato clinico rimane a oggi ancora assai controverso. Sebbene l’ipertiroidismo subclinico sia nella maggioranza dei casi una condizione clinica asintomatica, è altrettanto noto come esso si associ a un aumentato rischio di aritmie (più frequentemente la fibrillazione atriale) e ad alterazioni morfo-funzionali cardiache determinando un aumento di morbilità e mortalità cardiovasco- lare. Scopo del presente studio è stato quello di valutare retrospetti- vamente le alterazioni di differenti indici elettrocardiografici in pazienti diabetici eutiroidei che, dopo aver intrapreso terapia con metformina, hanno sviluppato riduzione/soppressione dei valori di TSH comparando i dati con quelli ottenuti in pazienti con iper- tiroidismo subclinico secondario a patologie tiroidee o a terapia soppressiva con L-tiroxina. I parametri elettrocardiografici (frequenza cardiaca, durata del- l’onda P, indice di dispersione dell’onda P, QT max, QT min, indice di dispersione dell’intervallo QT) sono stati valutati in 23 pazienti diabetici in terapia con metformina prima e dopo 6 mesi dall’instaurarsi della soppressione del TSH e in 31 con- trolli con ipertiroidismo subclinico. Nessuna modifica significa- tiva è stata osservata tra i parametri elettrocardiografici rilevati prima e dopo la riduzione del TSH. Al contrario, significative dif- ferenze nella durata dell’onda P (102,9 ± 7,4 vs 92,1 ± 5,8 ms, p < 0,001), dell’indice di dispersione dell’onda P (13,1 ± 3,4 vs 7,1 ± 3,5 ms, p < 0,001), del QT max (399 ± 18 vs 388 ± 16 ms, p = 0,024), del QT min (341 ± 14 vs 350 ± 17 ms, p = 0,038) e di quello dell’intervallo QT (49,9 ± 9,6 vs 30,9 ± 9,2 ms, p < 0,001) sono state rilevate tra i controlli con iperti- roidismo subclinico e il gruppo di pazienti diabetici con valori ridotti/soppressi di TSH. I risultati del nostro studio evidenzierebbero come l’effetto di riduzione/soppressione del TSH osservato in alcuni pazienti dia- betici in terapia con metformina non si associ a marker periferi- ci cardiaci da eccesso di ormoni tiroidei. L’alterazione del profilo tiroideo metformina-indotto sembrerebbe non indicativo di iper- tiroidismo subclinico, suggerendo quindi che non sussiste la necessità di sottoporre a stretti controlli della funzione tiroidea i pazienti diabetici in terapia con metformin

High wall stress may predict the formation of stent-graft-induced new entries after thoracic endovascular aortic repair

PURPOSE: To explore the potential role of morphological factors and wall stress in the formation of stent-graft-induced new entries (SINE) based on computed tomography (CT) images after thoracic endovascular aortic repair (TEVAR). CASE REPORT: Two female patients aged 59 years (patient 1) and 44 years (patient 2) underwent TEVAR for type B dissection in the chronic (patient 1) or subacute (patient 2) phase. CT scans at 3-month follow-up showed varying degrees of false lumen thrombosis in both patients. At 14-month follow-up, a SINE was observed in patient 1 while the dissected aorta in the other patient remained stable. Morphological and finite element analyses were performed based on the first follow-up CT images. The computational results showed that the SINE patient had higher stent-graft tortuosity than the non-SINE patient and much higher wall stress in the region close to the distal SINE. CONCLUSION: This case study suggests that high stent-graft tortuosity can lead to high wall stress, which is potentially linked to the formation of SINE. Further large population-based studies are needed to confirm this preliminary finding

Hybrid Risk-based LCA: An innovative holistic approach to improve the acid gas to syngas (AG2S) process

The sustainable development has recently become the cornerstone of the environmental policy worldwide and a leading principle for resource management. The philosophy lies in a continuous demand of innovative choices able to ensure the existing productive systems survival through a new design paradigm shift. In this regard, the technological innovation should be always driven by the sustainability concept: the economic, societal and environmental impact ought to be continuously fostered to the systems\u2019 sustainable improvement. This demanding goal can be accomplished with a blended Life Cycle (LCA) and Life Risk (LRA) Assessment to highlight the process potential health and environmental impacts. LRA is the process in which imposed risks by the inherent hazards linked to a process are continuously assessed (quantitatively or qualitatively). LCA instead is the process that analyses and assesses the environmental impact of a material, product or service throughout its entire life cycle. LCA and LRA are typically driven by two different approaches, respectively a deterministic and a stochastic approach. This usually drives an unconnected use of LCA and LRA in the quantification of products and processes potential impact and determines controversial decisions with respect to a balance between environmental impacts and operational risks. The new paradigm suggests a unified blended LCA \u2013 LRA approach that is applied at a preliminary stage to an innovative Acid Gas to Syngas (AG2S) process for CO2 emission reduction and on-site reuse, avoiding the costly and hazardous transportation step

Effect of Hypnotic Group Treatment on Distress Psychopathology in Mixed-group Outpatients with Depression and Anxiety

Background: There is evidence of hypnosis being effective in reducing both emotional distress, anxiety, and depression. Hypnosis as a technique promotes enhanced mental mastery over the body. This may result in hypnosis being particularly salient in treating distress associated with somatic and psychological symptoms. Objective: This research aims at verifying the effectiveness of a group treatment, which provides for the use of hypnosis-related techniques in mixed-group outpatients with anxiety or depression. Methods: Participants. 31 outpatients (average age= 49.005; DS =12.1) including 13 with mild-moderate depression (average age= 49.17; DS=12.20) and 18 with mild-moderate anxiety (average age=48.84; DS=13.02). Procedure. The group treatment comprised 8 sessions, during which a hypnotic state was induced, aimed at generating a sensation of profound wellbeing in the participants. They could share their experience in a penultimate group session, and were provided with individualised recommendations on nutrition and lifestyle in the last individual session. Patients were prescribed to practice self-hypnosis every day at home with the support of a CD-ROM. Psychopathological symptomatology (SCL-90R), depression (BDI), and anxiety (STAI-Y1, SAS) were assessed at pre, post, and 3-month follow-up. Statistical analysis. Friedman, Kruskal-Wallis and Mann-Whitey tests were used. The Bonferroni\u2019s correction was applied as needed. The effect size (Cohen\u2019s d) was also measured. Results: For the total sample, for all tests, significant differences were observed in the phases. The effect size was found to vary from \u201csmall\u201d at pre to \u201dmedium\u201d at post. A \u201clarge\u201d effect size was observed when comparing pre and follow-up phases. An overall reduction in the symptoms of distress measured by the SCL-90 R \u2013 with the anxiety group showing better outcomes \u2013 alongside with an improvement in the symptoms of depression and anxiety were observed in all participants. Conclusion: The clinical impact appears to be relevant, as shown by the values for d. The treatment is cost-effective for highly prevalent disorders in outpatients. The outcomes of this study support the effectiveness of hypnotic group treatment

Oral liquid L-thyroxine (L-t4) may be better absorbed compared to L-T4 tablets following bariatric surgery.

Drug malabsorption is a potential concern after bariatric surgery. We present four case reports of hypothyroid patients who were well replaced with thyroxine tablets to euthyroid thyrotropin (TSH) levels prior to Roux-en-Y gastric bypass surgery. These patients developed elevated TSH levels after the surgery, the TSH responded reversibly to switching from treatment with oral tablets to a liquid formulation

Anabolic steroids purchased on the Internet as a cause of prolonged hypogonadotropic hypogonadism

OBJECTIVE: To report a case of hypogonadotropic hypogonadism due to the chronic abuse of anabolic steroids purchased over the Internet. DESIGN: Case report. SETTING: Endocrinology unit of the University of Brescia. PATIENT(S): A 34-year-old man. INTERVENTION(S): A single dose (100 μg) of triptorelin (triptorelin test). MAIN OUTCOME MEASURE(S): Clinical symptoms, androgen normalization, levels of serum testosterone, follicle-stimulating hormone, and luteinizing hormone. RESULT(S): Within 1 month, the patient's serum testosterone was in the normal range, and he reported a return to normal energy and libido. CONCLUSION(S): The World Anti-Doping Code has proved to be a very powerful and effective tool in the harmonization of antidoping efforts worldwide, but it is insufficient to combat this illegal phenomenon. To tackle the serious side effects caused by doping we believe that it is necessary to increase monitoring and adopt severe sanctions, particularly with regard to Internet sites